Does the Timing of Surgical Debridement Affect Outcomes in Septic Arthritis of the Native Hip and Knee? A Propensity-weighted Analysis

Background Septic arthritis of the native hip and knee can cause irreversible cartilage damage and systemic illness. Because operative debridement provides source control, delaying it may permit infection to progress, potentially increasing the need for repeat surgery and the risk of death; however, evidence examining these associations remains limited. Questions/purposes Is delayed debridement associated with increased risk of (1) repeat debridement or (2) 1-year mortality in septic arthritis of the native hip and/or knee? Methods We performed a retrospective cohort study using the Florida State Inpatient Database, a statewide, all-payer database that records procedures by hospital day and includes longitudinal patient identifiers. Between October 2015 and December 2022, we identified 3587 adult admissions involving septic arthritis of the native hip (n = 1014) or knee (n = 2573) treated with surgical debridement. We excluded 1% (42 of 3587) of admitted patients in whom the first debridement occurred after hospital day 10, leaving 99% (3545 of 3587) for analysis (hip n = 1001; knee n = 2544). No included outcome or covariate data were missing. In the screened hip and knee cohorts, the mean ± SD ages were 55 ± 17 years and 60 ± 16 years, respectively, and 46% (462 of 1014) and 34% (879 of 2573) were female. Debridement occurred on hospital days 0 to 1 in 51% (506 of 1001) of hip admissions and 59% (1510 of 2544) of knee admissions; the remaining 49% (495 of 1001) and 41% (1034 of 2544), respectively, underwent debridement on day 2 or later. Stabilized inverse probability-of-treatment weighting was used to balance measured baseline covariates. Weighted log-binomial regression was used to estimate adjusted relative risks (RRs) and 95% confidence intervals (CIs). Results Among patients with septic knee arthritis, debridement on day 2 or later was associated with a higher risk of repeat debridement than debridement on days 0 to 1 (13% [133 of 1034] versus 5% [72 of 1510], adjusted RR 2.40 [95% CI 1.81 to 3.19]; p < 0.001). One-year mortality also was higher after debridement on day 2 or later (11% [118 of 1034] versus 6% [88 of 1510], adjusted RR 1.54 [95% CI 1.17 to 2.02]; p = 0.002). Among patients with septic hip arthritis, repeat debridement was no different between those treated on day 2 or later and those treated on days 0 to 1 (11% [55 of 495] versus 7% [37 of 506], adjusted RR 1.43 [95% CI 0.95 to 2.15]; p = 0.09). One-year mortality also was no different between the hip timing groups (9% [43 of 495] versus 7% [35 of 506], adjusted RR 1.19 [95% CI 0.77 to 1.85]; p = 0.44). Conclusion Surgeons should prioritize prompt debridement of septic knee arthritis, and hospitals should implement coordinated pathways to avoid preventable delays. No timing-specific recommendation can be made for septic hip arthritis based on our findings. Larger multicenter studies with granular data on presentation, diagnostic aspiration, antibiotic administration, and debridement are needed to clarify whether debridement timing influences outcomes in septic hip arthritis and to distinguish preventable delays from those related to diagnostic uncertainty or the management of medical comorbidities. Level of Evidence Level III, therapeutic study.